Celiac Disease(Gluten-Sensitive EnteropathyCeliac (SEE-lee-ak) disease is an inflammatory gastrointestinal (GI) syndrome characterized by an inappropriate immunological response to the gluten found in wheat, barley, rye, triticale and often oats (by contamination) by people who are genetically predisposed.

The GI tract regularly interacts with millions of antigens from food ingestion but is protected by chemical and physical barriers that can digest potential antigens from food and bacteria. A normal GI system is able to recognize proteins, peptides and cellular components and designate appropriate immune responses to foreign or potentially harmful antigens. In someone with Celiac Disease, the system creates an abnormal immune response when exposed to gluten which leads to intestinal damage and flattening of its villus lining, malabsorption, malnutrition and possible malignancy. Other names for the disease include Celiac Sprue, gluten-enteropathy or non-tropical sprue.

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CauseCeliac Disease is a genetic disorder that may appear any time within one's life or it may be triggered by GI surgery, stress, pregnancy, viral infection. It may also be discovered while being treated for other problems. The diagnosis may be made from a combination of clinical, laboratory and histological analysis but a small intestine biopsy is the most valid medical confirmation.

Signs & Symptoms
Celiac disease does not have any typical signs and symptoms. It ranges from people having no symptoms to mild,moderate, and severe.

Symptoms of Celiac Disease:
  • diarrhea
  • abdominal pain
  • bloating

The severity of symptoms often depends on a person's degree of malabsorption, but symptoms can also be related to malnutrition related to mineral and vitamin deficiencies.

Symptoms of malabsorption are often due to fat malabsorption. In this disease, the intestinal villi are destroyed. These finger-like projections in your small intestine help to absorb nutrients. Enzymes that help break down larger molecules, like carbohydrates, are also destroyed. A common example in Celiac disease is lactose being unable to be broken down as often because much of the enzyme lactase has been destroyed. This results in lactose malabsorption.

  • symptoms of malnutrition include:
  • diarrhea
  • bad smelling gas
  • steatorrhea (fatty stool)
  • bloating

When malnutrition occurs, common symptoms include:
  • weight loss
  • muscle weakness
  • anemia
  • fluid retention
  • nerve damage
  • osteoporosis

Deficiencies in vitamins and minerals B12, iron, calcium, vitamin D, and thiamine are often the culprits of these symptoms.




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Medical Treatment
The number one treatment for celiac disease is a gluten-free diet but sometimes that is not enough. Medication can suppress inflammatory of immunologic responses. These medications are corticosteroids, and immune-suppressive drug.
If the patient has severe malnutrition vitamin and mineral supplements might be recommended such as:
  • Calcium
  • Iron
  • Folate
  • Vitamin D
  • Vitamin K
  • Vitamin B-12



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Dietary Treatment
It is important to remember that this disease cannot be cured. But with proper diet, and medical help the symptoms can go away. "You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease."
The first step in the nutrition therapy is a gluten-free diet. Omitting gluten from the diet is a lifelong change. Foods containing gluten include wheat, rye, and barley. These can be substituted with corn, potatoes, rice, soybean, tapioca, arrowroot, amaranth, quinoa, millet, and buckwheat. Some of these substitutions can still be contaminated with gluten so it is vital to check all food labels.



Resources
1) Mahan, LK, Escott-Stump, S. Krause’s Food and Nutrition Therapy. 12th Ed. WB Saunders., 2008.
2) Mayo Foundation for Medical Education and Research. Celiac Disease.
http://www.mayoclinic.com/health/celiac-disease/DS00319. Accessed 17 April 2012. Web.
3) Escott-Stump, S. Nutrition and Diagnosis-Related Care, 6th Ed. Wolters Kluwer. 2008.
4) Marks, Jay W. M.D. Celiac Disease. Accessed 17 April 2012. http://www.medicinenet.com/celiac_disease/page3.htm#toce
5) Board, A.D.A.M. Editorial. "Causes, Incidence, and Risk Factors." Celiac Disease - Sprue. U.S. National Library of Medicine, 18 Nov. 0000. Web. 18 Apr. 2012. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/>.